Technical Product Profile · Opacity Considerations ... that significantly advanced the clinical...

Technical Product Profile

™FiltekSupreme UltraUniversal Restorative

2 3M™ Filtek™ Supreme Ultra Universal Restorative Technical Product Profile

Table of ContentsIntroduction .............................................................................................................................. 3

Product Description .................................................................................................................. 4

Indications for Use ......................................................................................................................... 4

Composition ................................................................................................................................... 4

Shades ............................................................................................................................................. 5

Fluorescence and Opalescence .................................................................................................. 6

Shade Basics ................................................................................................................................... 6

Color ........................................................................................................................................ 6

Opacity Considerations ........................................................................................................ 7

Opinion Leaders ..................................................................................................................... 8

Shade Selection Tips and Hints for 3M™ Filtek™ Supreme Ultra Universal Restorative ......................................................... 9

Shade Wheel .................................................................................................................................. 10

Background ............................................................................................................................. 12

Fillers ............................................................................................................................................... 12

Microfills ................................................................................................................................. 12

Hybrids, Microhybrids and Nanohybrids ...........................................................................13

Nanocomposites .................................................................................................................... 14

Filler Improvements in 3M™ Filtek™ Supreme Ultra Universal Restorative ................ 15

Resin System ..................................................................................................................................16

In Vitro Handling Evaluations ...................................................................................................... 16

Physical Properties ................................................................................................................. 18

Polish Retention ............................................................................................................................ 18

Toothbrush Abrasion ............................................................................................................. 18

Wyko Images ..........................................................................................................................20

3-Body Wear ................................................................................................................................ 24

Fracture Toughness ..................................................................................................................... 25

Compressive and Diametral Tensile Strength ..........................................................................26

Flexural Strength and Modulus ................................................................................................. 28

Volumetric Shrinkage .................................................................................................................. 30

Field Evaluation ........................................................................................................................ 31

Handling Acceptability ............................................................................................................... 32

Questions and Answers .......................................................................................................... 36

Endnotes .................................................................................................................................. 37

Technical Data Summary ....................................................................................................... 38

33M™ Filtek™ Supreme Ultra Universal Restorative Technical Product Profile

IntroductionBuilding upon over 40 years of innovation in the field of restorative dentistry, at the turn of this century, 3M created a new category of dental material—the nanocomposite.

Through precise manipulation of the filler architecture at the nanoscale, 3M developed a breakthrough composite filling material, 3M™ Filtek™ Supreme Universal Restorative, that significantly advanced the clinical performance of universal composites. Up until the launch of this product, dentists desiring the highest esthetics in direct composite restorations chose microfills. Microfills were considered the gold standard in esthetics; however, their lack of strength, wear resistance and radiopacity limited their use to only select anterior restorations. Hybrid composites had high filler loading, but the average particle size was in the submicron range, which somewhat limited their esthetic qualities. Hybrid composites provide the strength, wear resistance and radiopacity necessary for anterior and posterior use. In 2002, 3M launched Filtek Supreme restorative. This was the first product that utilized nanotechnology to provide the esthetics of a microfill and the strength of a hybrid. All of the filler particles in this novel composite were engineered nanoparticles.1 This technology provided lasting polish, excellent handling and wear similar to enamel.2

Subsequently, as a result of feedback from dentists, 3M™ Filtek™ Supreme Plus Universal Restorative was launched in 2005. The shades were optimized to provide more vibrant, lifelike restorations as a result of increasing the value or brightness of the shades.

Since the original introduction of Filtek Supreme restorative, 3M has continued discussions with opinion leaders and general dentists regarding potential improvements desired. Based on these discussions, focus groups and other market research methods, additional improvements are realized with the introduction of 3M™ Filtek™ Supreme Ultra Universal Restorative. The following improvements have been made to the system:

Easier-to-use shading system

• Color coding by opacity

• New, easier-to-read labeling

• Extended Body shade range

Even better polish retention

Improved fluorescence

Supreme-like handling for all opacities

Improved Translucent shades

• Better Translucent shade handling

• Availability of Translucent shades in capsules

• Modified Translucent shade offering

• Translucent shades are radiopaque

3M™ Filtek™ Supreme Ultra Universal Restorative is a visible-light-activated composite designed for use in anterior and posterior restorations. All shades are radiopaque. A dental adhesive, such as those manufactured by 3M, is used to permanently bond the restoration to the tooth structure. The restorative is available in a wide variety of Dentin, Body, Enamel and Translucent shades. It is packaged in syringes and single-dose capsules.

Indications for Use Filtek Supreme Ultra restorative is indicated for use in:

• Direct anterior and posterior restorations (including occlusal surfaces)

• Core build-ups

• Splinting

• Indirect restorations (including inlays, onlays and veneers)

CompositionTheresinsystemisslightlymodifiedfromtheoriginal3M™Filtek™Z250UniversalRestorative and 3M™ Filtek™ Supreme Universal Restorative resin. The resin contains bis-GMA, UDMA, TEGDMA, and bis-EMA(6) resins. To moderate the shrinkage, PEGDMA has been substituted for a portion of the TEGDMA resin in 3M™ Filtek™ Supreme Plus Restorative.

Thefillersareacombinationofnon-agglomerated/non-aggregated20nmsilicafiller, non-agglomerated/non-aggregated4to11nmzirconiafiller,andaggregatedzirconia/silicaclusterfiller(comprisedof20nmsilicaand4to11nmzirconiaparticles).TheDentin, Enamel and Body (DEB)3shadeshaveanaverageclusterparticlesizeof0.6to10microns.The Translucent (T)4shadeshaveanaverageclusterparticlesizeof0.6to20microns. Theinorganicfillerloadingisabout72.5%byweight(55.6%byvolume)fortheTranslucentshadesand78.5%byweight(63.3%byvolume)forallothershades.

Product Description


Figure 1: Opacity choices.

ShadesThe system is comprised of four opacities, listed here in decreasing order of opacity: Dentin (most opaque), Body, Enamel and then Translucent (very transparent). TheopacitydifferencesareillustratedinFigure1.Theclarity of the print under the 1 mm composite discs exhibits the opacity. The Translucent shades are very clear, hence the print appears relatively unchanged from the surrounding type. The Enamel shades have opacity similartotoothenamel.Theprintisslightlyfuzzybutveryreadable through the disc. The Body shades are slightly more opaque, less translucent than the Enamel shades to enable use in single-shade restorations. The print is still readablebutveryfuzzy.Dentinshadeshavethehighestopacity. In multi-shade restorations, the Dentin shades are used to replace the more opaque dentin tooth structure, alter underlying dentin color and block shine-through in anterior restorations.


Theshadeofferingwasmodifiedfrom 3M™ Filtek™ Supreme Plus Universal Restorative. Thedifferencesintheshadeofferingincludeareductionin the Dentin shades (eliminated A6D, C6D, XWD). TheBodyshadeofferingwasbroadenedbyadding A6B and B5B for cervical restorations and D3B. An Enamel shade, XWE, was also added. Additionally, the Violet and Yellow Translucent shades were replaced with Blue and Amber Translucent.

The chart to the right also demonstrates the color coding used in the 3M™ Filtek™ Supreme Ultra Universal Restorative system. The darker the color code, the more opaque the composite.

3M™ Filtek™ Supreme Ultra Universal Restorative Shade Offering

Dentin Body Enamel TranslucentA1D A1B A1E ClearA2D A2B A2E BlueA3D A3B A3E Gray

A3.5B AmberA4D A4B

A6B B1B B1E B2B B2E

B3D B3B B5B C1B C2B C3B

C4D D2B D2E D3B

WD WB WE

XWB XWE

The shade system is based on the VITA classical Shade Guide with the following exceptions:

For bleached teeth: White Dentin, Body and Enamel (WD, WB, WE), Extra White Body and Enamel (XWB and XWE)

For cervical restorations: A6B and B5B

Translucent shades: Clear, Blue, Gray and Amber

Translucent

Dentin

Body

Enamel

Fluorescence and OpalescenceTwoadditionalestheticpropertiesofnaturaldentitionarefluorescenceandopalescence.Itisthoughtthatboth of these properties contribute to the vitality and lifelike appearance of dentition. In natural teeth, dentin (morespecificallythehydroxyapatitemineralsandorganicmatrix)exhibitshigherfluorescencethanenamel.Fluorescence occurs when energy is absorbed and emitted at a longer wavelength. In teeth, this means the absorption of light in the UV region (350–365 nm) and emitting light in the visible region (~400 nm).5 As shown inFigures2and3,teethfluoresceblue-white.Notethatsomematerialsfluorescemorethanthenaturaltooth,whileothers,e.g.,3M™Filtek™SupremeUltraUniversalRestorative,fluoresceatasimilarlevelandcolor.6


Opalescence, on the other hand, is related to how a material scatters the shorter wavelengths of light. This isdemonstratedbyabluishappearanceunderreflectedlightandorange/brownundertransmittedlight.7 Naturalenamelexhibitsanopalescenteffect.Bychangingthenanoclusterused,theTranslucentshades of Filtek Supreme Ultra restorative were specially formulated to provide the opalescence in the range of literature values for human enamel.8

Shade Basics

Color

• Hue is the actual color of the material. The bar below demonstrates the hues from blue to yellow.

• VITA classical Shade Guide Shade Family (Hue)

A shades Red-brown character

B shades Red-yellow character

C shades Gray character (lower value)

D shades Red-gray character (lower value)

• Chroma is the intensity of the shade. The higher the number (e.g., A3 vs. A1) within a shade family, the more intense the color (A3 is more intense than A1).

• The value (amount of white or black) is higher (whiter) for the A and B shades. The C and D shades have lower value (grayer) than the A and B shades. Very generally speaking, the C shades are lower-value A shades. Value is often thought of as the most important color aspect.

Figure 2: Dentin, Enamel or Body shades.

Grandio® A2 Tetric EvoCeram®

A2

EsthetX® A3 Premise™ A2

3M™ Filtek™ Supreme Ultra A2B

EsthetX® A2 EsthetX® HD A2

3M™ Filtek™ Supreme Ultra CT

3M™ Filtek™ Supreme Ultra GT

3M™ Filtek™ Supreme Ultra BT

3M™ Filtek™ Supreme Ultra AT

3M™ Filtek™ Supreme Plus CT

Vit-L- Escence™

TA

Grandio® Incisal

Figure 3: Translucent or Incisal shades.


Studies have indicated that tooth color, in adult teeth, is determined primarily by dentin. The enamel layer plays a very minor role in the actual tooth color.

• In young patients, teeth are brighter (higher value) and less translucent. With age, the enamel layer thins, exposing more dentin, so teeth appear darker, particularly in the gingival third.

• Areas of highest intensity of color (chroma) will be in the gingival region of the tooth due to a thinner enamel layer, so the dentin is more visible.

• The Body region is a combination of the dentin color and the slight contribution by the enamel layer color and surface morphology. Literature suggests that the intensity of the body is 1–2 shades lighter than the gingival area.

• The incisal area exhibits a high degree of translucency as the amount of dentin present is decreased toward the incisal edge.

Opacity ConsiderationsWhen light contacts a tooth:

•Enameldiffusesandtransmitslight.Ifthedentinlayerisverythinorifthereisnodentinbehind the enamel layer (as in the incisal edge), some of the light is transmitted through the toothtotheoralcavity.Theoralcavitycanreflectlightbackthroughtheenamel.

• When light encounters dentin, some of the light isabsorbedandsomeisreflectedbackthrough the enamel.

•Thelightthatisreflectedandrefractedbacktothe eye produces the color of the tooth.

• The surface texture of a tooth plays a role in the perceived color, i.e., a smoother surface will appear whiter (or higher value) than an irregular surface.

Color Regions

Gingival or Cervical

Body

Incisal

Transmission

Gloss

DiffuseReflection


Opinion LeadersEighteen opinion leaders were invited to share their views regarding case presentations (recommended treatment and technique), education methods, strengths and weaknesses ofcurrentcompositesandshadeguideofferings.Keyfindingsaredetailedbelow.

• It is important to gain agreement between patient and dentist as to the level of esthetics required.

• Shade guides can be used to start the shade selection process; however, shade mock-ups, using the composite in vivo, are the best way to determine which composite shades are needed to blend with surrounding dentition.

•Theacceptabilityoftheresultantrestorationscanbeinfluencedbymanyfactors, including shades selected, depth of color and re-creation of the natural tooth appearance (e.g., provided by layering translucent materials over less translucent materials or creating appropriate translucency along incisal edge), surface polish and surface morphology and patients’ and dentists’ preferences.


Shade Selection Tips and Hints for 3M™ Filtek™ Supreme Ultra Universal Restorative 1. After pumicing the surface to remove any extrinsic stains, determine the shades needed

for the restoration prior to tooth preparation or rubber dam placement. A tooth that is desiccated will be lighter than normal. Therefore, a shade taken on a desiccated tooth will be lighter than the tooth upon rehydration.

2. During shade selection,

• If one shade is to be used,

– Select the Body shade by examining the center (body) portion of the tooth. Choose the composite shade most closely approximating the center portion of the VITA classical shade tab.

• If more than one shade is to be used to mimic actual tooth structure and increase the vitalityofthefinalrestoration,eitherusetheshadewheel(nextpage)oridentifywhichopacities are to be used. To determine which shade to choose in a given opacity:

– Select the Dentin (or Body) shade by examining the exposed dentin or the gingival area of the tooth. Choose the composite shade most closely approximating the cervical portion(grindingofftheneckofthetabhasbeenrecommendedbysome)oftheVITAclassical shade tab.

– Select the Body shade by examining the center (body) portion of the tooth. Choose the composite shade most closely approximating the center portion of the VITA classical shade tab.

– Select the Enamel shade by examining the proximal or incisal area of anterior teeth, or from the cusp tips of posterior teeth. Choose the composite shade most closely approximating the center portion of the VITA classical shade tab.

– A Translucent shade (in the same color family) may be used to impart high translucency and increase the “depth” of the restoration.

3.Doamock-upoftherestorationpriortoetching.Thecolorofacompositewillbeaffectedby its thickness. Composites may change color upon curing. Place and cure composite material in the approximate thickness and area of the planned restoration. Obtain agreementwiththepatientofshadematch.Removemock-upeasilybyflickingitoffthetooth with an explorer.

4.Evaluateshadematchofthetabsandmock-upunderdifferentlightingconditions.

5.Whenfinishingandpolishingtherestoration,mimicthesurfacemorphologyof adjacent teeth.


Figure 4: Shade wheel: unsupported and supported restoration.

Shade WheelTo aid in the shade selection process, 3M™ Filtek™ Supreme Ultra Universal Restorative incorporates a unique (patented) shade selector wheel. Once a shade has been selected usingtheVITAclassicalShadeGuide,theselectoroffersrecommendationsforsingle-shade,two-shade or multi-shade restorations in supported and unsupported restorations (Figure 4).

Figure 5: Shade recommendation.

Figure 5 indicates the proposed shade combinations for a Class IV and other unsupported restorationsdeterminedtobeshadeA2.Severaloptionsareoffered,withfinalchoicedependinguponthesizeandestheticrequirementsoftherestoration.

Simpler shade recommendations are given for restorations that are supported by tooth structure. Posterior restorations are an ideal place to start exploring the esthetic options offeredbytheshadelayeringtechnique.


To use the wheel:

• Select VITA shade: Choose the composite shade most closely approximating the center portion of the VITA classical shade tab.

• Select the appropriate wheel side that corresponds to the type of restoration—e.g., supported or unsupported (Figure 4).

• Rotate the disc so that the VITA shade is visible in the innermost circle.

• Follow the 3M™ Filtek™ Supreme Ultra Universal Restorative shade combination recommendations outlined for Single, Dual or Multi shades (Figure 5).

Itshouldbenotedthatthistoolisaguideonly.Finalresultswillbeinfluencedbythethickness of composite layers, surrounding tooth structure, adjacent teeth, etc. Further, the layeringdiagramsdepictedontheshadeguideareofferedaspotentialsolutionsincreatingcertainestheticeffects.Forinstance,theTranslucentshademaybeappliedinternallyasindicated to create translucency at the incisal third of a Class IV restoration. Alternatively, while not diagrammed, the Translucent shade may be applied as the last facial or occlusal increment to create depth. As using the Translucent shade in this manner may tend to decrease the overall value of the restoration, choosing a shade one step lighter for the incrementimmediatelybelowtheTranslucentshademaymoderatethiseffect.


Figure6:Durafill® VS.

Figure7:Durafill® VS.

Fillers Microfills

Traditionalmicrofillsaremadefromfumedsilica,preparedbyapyrogenicprocess,withanaverageparticlesizeof0.04um.Typically,theprimaryparticlestendtoaggregate(thedegreeofaggregationvaries,dependingonthefillerusedinthemicrofillproduct).Breakdownofanyaggregatedparticlesintosmallerentitiesisdifficult,ifnotimpossible,toachieve.Thestructureoftheseaggregatesresultsinrelativelylowfillerloading.

In the SEM (Figure 6), courtesy of Dr. Jorge Perdigao,9 the surrounding resin matrix was removed with a solvent.10 ThefieldofviewofthisSEMdidnotincludeanyofthe prepolymerizedfiller,butfocusedinsteadontheindividual silica aggregates. Note that the particles appear to be in the 0.1umrange,significantlylargerthan0.04microns,asa resultoftheaggregation.Mostmicrofillmanufacturers addprepolymerizedfilledresinparticlestoincreasefiller loading.Prepolymerizedfillerismadebyaddingthefumed silicafillertoresin.Themixtureispolymerizedandthen ground to form particles. These ground particles are added to more resin and fumed silica filler.Evenbyusingthisprocess,microfillsstillhaveasubstantiallylowerfillerloadingthanhybrids, resulting in lower strength and wear resistance.

Residualmethacrylategroupsbindtheprepolymerizedparticlestotheresinmatrix.Theeffectivenessofthisbondisimpactedbytheamountofresidualdoublebondsonthesurfaceoftheseparticles.Duringthepolymerizationoftheprepolymerizedfiller,thereactionisdriventonearcompletion.Hence,thebondoftheprepolymerizedfillerparticlestotheresin is weaker than desired and breakdown frequently occurs at this interface. Additionally, traditionalmicrofillscontainingonlysilicafillerarenotradiopaque.Thesepropertieshavelimitedtheusefulnessofmicrofills,particularlyintheposteriorarea.

The AFM11 (Figure 7) is a 3D image of the surface of amicrofillafter6000cyclesoftoothbrushabrasion. Microfillshaveproventoretaintheirpolish(surface reflectivity)overtime.Theprepolymerizedfillerparticles are marginally more wear resistant than the surrounding matrix, resulting in small surface irregularities.

Background


Hybrids, Microhybrids and Nanohybrids

Hybrids, microhybrids and nanohybrids contain a broad distribution of particle sizes.Awidedistributionofparticlesizescanleadtohighfillerloadingwithresultant high strength and wear resistance. While they contain a small fraction offillerparticlesinthenanoparticlesizerange(lessthan0.1µor100nm),theyalsocontainarangeofsubstantiallylargerfillerparticles,whichinfluencesthe optical properties of these composites and detracts from polish retention (Figure8).Theaverageparticlesizeofhybrids,microhybridsandnanohybridsistypicallybelow1micron,butabove0.2microns.Thelargerparticlesizescanextend to well over 1 micron. They are typically manufactured by grinding or millinglargefillersintosmallerparticles.Thenanohybridshavesomeparticles inthenanofillersizerangelessthan100nm(0.1um),buttheyalsocontainparticlesinthesubmicronrange(0.2to1µ).

Figure 8: Left to right: EsthetX®HDHighDefinitionMicroMatrixRestorative,Grandio®SO Universal Nano Hybrid Restorative and Tetric EvoCeram® Universal.

When any of these materials are subjected to abrasion, the resin between andaroundtheparticlesislost,leadingtoprotrudingfillerparticles(bumps).Eventually,theentirefillerparticleispluckedfromthesurface,resultingincraters. These bumps and craters create a roughened surface, resulting in loss ofreflectivity(lossofpolishretention)ofthecompositesurface.TheAFMimages12(Figure9)showtheinfluenceofthelarge-tosmall-particleratiosandthenumberofsizesoftheparticlesafterthesurfacehasbeentoothbrushabraded.Thematerialshowninthefarrightcontainsprepolymerizedfillers,whicharetypicallylargerthanthetypicalinorganicfillers.Notetheroughness is clearly shown by the many peaks and valleys. The materials in the SEMs shown above correspond to the materials in the AFM images shown below.

Figure 9: Left to right: EsthetX®HDHighDefinitionMicroMatrixRestorative,Grandio®SO Universal Nano Hybrid Restorative and Tetric EvoCeram® Universal.


Nanocomposites

3Mmanufacturesmanyofitsfillersusingasolgelprocess.Thesolgel processisaroutewhereinfillersaremadefromliquidprecursors,ora“sol.” These liquids are chemically and mechanically processed to produce particles. Oneaspectofthisprocessresultsinsintering,whicheffectivelycoalesces primaryparticlestogethertoformlargerfillerparticles.Sinteringcanbe viewed as a type of melting process whereby the particles are softened, creating a surface which can attach to neighboring particles, resulting inaparticle-to-particlebond.Thesinteringprocesscanproducefillersthat arehighlydensifiedorcompacted,asfoundin3M™Z100™Restorative and3M™Filtek™Z250UniversalRestorative(Figure10).

In 2002, 3M discovered a way to modify the sintering process to produce loosely agglomerated nanoparticles, i.e.,nanoclusters.Althoughstructurallydifferentfromdensifiedparticles,thesenanoclustersbehavedsimilarlytothedensifiedparticlesfoundinothercompositesintermsofprovidinghighfillerloading.Thisresultedinamaterialwiththestrengthandwearofhybridswithsignificantlyimprovedpolishretentionandopticalproperties. This technology advance was used in 3M™ Filtek™ Supreme Universal Restorative.

FiltekSupremerestorativewasformulatedusingbothengineerednanoparticleandnanoclusterfillers.Thenanoclusterfillerparticlesconsistoflooselyboundaggregatesofengineerednanofillerparticles.Theadditionof engineered nanoparticles to formulations containing nanoclusters reduces the interstitial spacing of the fillerparticles,leadingtohigherfillerloadings.Thefilledmatrix(resinplusengineerednanoparticles)isharderandmorewearresistantthanresinalone.Theincreasedfillerloadingresultsinbetterphysicalpropertiesandwearresistance.TheDEBshadefillers(Figure11)ofFiltekSupremerestorativewerecompositionallydifferentthantheTshadefillers(Figure11).ThenanoclustersintheDEBshadeswerezirconia/silica(therebyproducing a radiopaque material), while the T shades contained silica clusters (hence, no radiopacity). The ratio ofnanoclusterstoengineerednanoparticleswasdifferentfortheDEBshadesthanfortheTshadeinFiltekSupremerestorative.Nanoclusterscomprisedabout90%ofthefillerintheDEBshades,butonly50%ofthefillerintheTshades.TheAFMimages13showthesurfacesaftertheyweretoothbrushabraded.TheZscaleissmallerintheseimagesthanintheAFMimagesshownpreviously,whicheffectivelyincreasesthemagnificationof the surface. During abrasion, the wear rate and wear pattern of the clusters is closer to the wear rate of the surroundingfilledmatrix,particularlyinthe3M™Filtek™SupremePlusUniversalRestorativeTranslucentshades (Figure 12). This increases the polish retention of the cured composite when compared to traditional hybrid composites.

Figure 11: Left to right: 3M™ Filtek™ Supreme Plus Universal Restorative (DEB shades) and Filtek Supreme Plus restorative (T shades).

Figure10:3M™Filtek™Z250 Universal Restorative.

Figure 12: After abrasion, left to right: 3M™ Filtek™ Supreme Plus Universal Restorative (DEB shades) and Filtek Supreme Plus restorative (T shades).


Figure 14: Left to right: nanoclusters at 100,000x 3M™ Filtek™ Supreme Ultra Universal Restorative (DEB shades) and Filtek Supreme Ultra restorative (T shades).

Thisfillertechnologywasimprovedagain. The manufacturing process, where the clusters are formed,wasmodifiedtoproducelesssintering. Once again, the nanoclusters are produced in abroadrangeofsizes,enablingahighfillerloading.As the particles are not as strongly sintered, theclustersizerangecouldbebroadened (vs. 3M™ Filtek™ Supreme Plus Universal Restorative)withoutaffectingpropertiessuchaspolish retention. These nanoclusters still have the structural integrity to provide strength, fracture and wear resistance. In the SEMs (Figure 13),9 note the shape of the primary nanoparticles are still evident in the clusters. Both materials (DEB and T shades) containzirconia/silicaclusters(Figure14),silica nanoparticlesandzirconiananoparticles.Theratio of nanoclusters to nanoparticles is similar in both formulations. Compositionally, both clusters are the same. In order to achieve the high degree of transparency and opalescence required for the T shades, the manufacturing process is slightly different.BoththeDEBshadesandtheTshades are radiopaque. During abrasion, their wear rate andpatternaremoresimilartothenanofilled matrix surrounding the clusters than Filtek Supreme Plus restorative DEB and T shades. Note that in the AFM 3D image (Figure 15), the Z-scaleisdifferentthanpreviousAFMimages, resultinginagreatermagnificationofthese surfaces.Thisgreatermagnificationexacerbates the very slight irregularities in the surfaces. Figure 15: Left to right: after abrasion, 3M™ Filtek™ Supreme Ultra

Universal Restorative (DEB shades) and Filtek Supreme Ultra restorative (T shades).

Figure 13: Left to right: nanoclusters at 30,000x 3M™ Filtek™ Supreme Ultra Universal Restorative (DEB shades) and Filtek Supreme Ultra restorative (T shades).

Filler Improvements in 3M™ Filtek™ Supreme Ultra Universal Restorative


In Vitro Handling EvaluationsDuring the years 3M™ Filtek™ Supreme Universal Restorative has been on the market, dentists have commented favorably on the handling of the Dentin, Enamel and Body shades. As such, when dentists and opinion leaders were asked to identify features to improve in this iteration, they indicated the handling acceptability needed to be maintained. At the same time, they indicated the handling of the Translucent shades needed to be improved.

Handlingofcompositesisinfluencedbybothresinandfiller.Whilethefillercompositionof Filtek Supreme Ultra restorative Dentin, Enamel and Body shades is similar to its predecessor,themorphologyoftheclustersisdifferent.BoththefillercompositionandmorphologyweremodifiedtoproducethenewTranslucentshadeformulation.

Hence, numerous handling evaluations were conducted throughout the development process with dentists. Blind evaluations were done with anterior and posterior restoration in heated typodonts. Dentists were asked a series of questions about the handling of each paste. There were over 500 evaluations of this type conducted. Filtek Supreme Plus restorative was included as a blind control in these evaluations. Overall, the handling of Filtek Supreme Ultra restorative met or exceeded the acceptability of the handling of Filtek Supreme Plus restorative DEB shades. The handling acceptability of the T shades of Filtek Supreme Ultra restorative exceeded that of Filtek Supreme Plus restorative T shades.

Resin SystemTheresinsystemintroducedwith3M™Filtek™Z250UniversalRestorativeandused in 3M™ Filtek™ Supreme Plus Universal Restorative comprises the majority of the 3M™ Filtek™ Supreme Ultra Universal Restorative resin system. The resin consists of three majorcomponents.ThemajorityofTEGDMA(inthe3M™Z100™Restorativesystem)wasreplaced with a blend of UDMA (urethane dimethacrylate) and Bis-EMA(6) (Bisphenol A polyethylene glycol diether dimethacrylate). UDMA and Bis-EMA(6) resins are of higher molecular weight than TEGDMA and therefore have fewer double bonds per unit of weight. The high molecular weight materials also impact the measurable viscosity. However, the higher molecular weight of the resin results in less shrinkage, improved aging and a slightly softer resin. TEGDMA and PEGDMA are used in minor amounts to adjust the viscosity. PEGDMA was used to replace part of the TEGDMA component to moderate shrinkage in Filtek Supreme Ultra restorative.


Figure 16: Handling Acceptability. Source: 3M internal data

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Inoneinvitrostudy,dentistswereaskedtoevaluateaseriesofpastesthatincludeddifferentlots of 3M™ Filtek™ Supreme Ultra Universal Restorative representing potential handling targets and two lots of 3M™ Filtek™ Supreme Plus Universal Restorative (Figure 16). About one-third of the evaluators were current Filtek Supreme Plus restorative users. The materials were evaluated in random order, restoring a Class II and Class IV preparation on heated typodonts. The handling acceptance of the DEB shade pastes is shown in Figure 16. Greater than70%ofthedentistsevaluatingthesematerialslikedthehandling,andconsequentlyidentifiedthehandlingspecificationrange.Inadditiontotheoverallacceptability,thefollowinghandlingattributeswerealsorated:viscosity,stickinesstoinstrument,flow,ability to hold shape or resist slump, ease of veneering (for anterior restorations), cavity and marginal adaptation, and packability (for posterior restorations only). In all cases, the Filtek Supreme Ultra restorative materials were rated as the same or better than the Filtek Supreme Plus restorative materials.

An evaluation comparing the two Translucent shade formulations yielded even better results. A similar method was followed but with three Filtek Supreme Ultra restorative Translucent shadelotsrepresentingdifferentpotentialhandlingtargetsandoneFiltekSupremePlusrestorative Translucent shade lot. Nominally, twice as many dentists liked the handling of Filtek Supreme Ultra restorative T shade lots as Filtek Supreme Plus restorative T shades. (Figure16)Inaddition,significantimprovementswerealsonotedintheindividualhandlingattributes:viscosity,stickinesstoinstrument,flow,abilitytoholdshapeorresistslump,andease of veneering.

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Physical Properties

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3M™ Filtek™ Supreme Ultra Universal Restorative (T shades)

3M™ Filtek™ SupremePlus Universal Restorative (DEB shades)

Durafill® VSRenamel® Microfill

Polish Retention

Figure17:Polishretentionversusmicrofills.Source: 3M internal data

Polish RetentionToothbrush Abrasion Composite materials were shaped into tiles and thoroughly cured. The surfaces were polished wet using a Beuhler variable-speed grinder-polisher to remove the air-inhibited layer and to ensure a uniform surface. They were stored in water at 37ºC for 24 hours. Gloss was measured. The samples were brushed with toothpaste and a toothbrush that was mounted on an Automatic Toothbrush Machine. Gloss measurements were taken after 500 cycles and then every 1,000 cycles. The test was terminated after 6,000 toothbrush strokes.


Figure 18: Polish retention versus other universal restoratives. Source: 3M internal data

• In this test, even after only 500 cycles of toothbrush abrasion, the polish retention (gloss) of 3M™Filtek™SupremeUltraUniversalRestorativeDEBshadesandTshadeswasstatisticallysignificantlyhigherthanthemicrofillproductsDurafill® VS and Renamel®MicrofillandthehybridcompositesCeram-X™ Nano Ceramic Restorative, Estelite® Sigma Quick, EsthetX®HDHighDefinitionMicroMatrixRestorative, Gradia® Direct X, Grandio®SO Universal Nano Hybrid Restorative, Herculite® XRV Ultra™, Premise™ Universal Composite, Tetric EvoCeram® Universal, TPH® 3flowLiquidMicroHybridRestorativeandVenus®.

• Both compositions of Filtek Supreme Ultra restorative were better in gloss than 3M™ Filtek™ Supreme Plus Universal Restorative after 2,000 cycles of toothbrush abrasion.

•After6,000cycles,theglossofFiltekSupremeUltrarestorativeTshadeswasbetterthanDurafill® VS, Renamel®Microfill,Ceram-X™NanoCeramicRestorative,Estelite® Sigma Quick, EsthetX® HD High DefinitionMicroMatrixRestorative,Gradia® Direct X, Grandio®SO Universal Nano Hybrid Restorative, Herculite® XRV Ultra™, Premise™ Universal Composite, Tetric EvoCeram® Universal, TPH® 3flowLiquid Micro Hybrid Restorative and Venus®.

• After 6,000 cycles, the gloss of Filtek Supreme Ultra restorative DEB shades was statistically better than Durafill® VS, Renamel®Microfill,Ceram-X™NanoCeramicRestorative,EsthetX®HDHighDefinitionMicroMatrix Restorative, Gradia® Direct X, Grandio®SO Universal Nano Hybrid Restorative, Herculite® XRV Ultra™, Premise™ Universal Composite, Tetric EvoCeram® Universal, TPH® 3flowLiquidMicroHybridRestorative and Venus®.

3M™ Filtek™ Supreme UltraUniversal Restorative (DEB shades)

3M™ Filtek™ Supreme UltraUniversal Restorative (T shades)

3M™ Filtek™ Supreme PlusUniversal Restorative (DEB shades)

Ceram-X™ NanoCeramic Restorative

Estelite® Sigma Quick

EsthetX® HD High DefinitionMicro Matrix Restorative

Gradia® Direct X

Grandio®SO UniversalNano Hybrid Restorative

Herculite® XRV Ultra™

Premise™ Universal Composite

Tetric EvoCeram® Universal

0 10

TPH® 3flow LiquidMicro Hybrid Restorative

Venus®

10020 30 40 50 60 70 80 90Gloss Units

Cycles of Toothbrush Abrasion: 6,0002,000500Initial

Polish Retention


Wyko ImagesTheseimagesweregeneratedusingaWykoOpticalprofiler.ThismethodprovidesawiderfieldofviewthanthepreviousAFMimages.Thebartotherightofthescannedimageidentifiesthecolorcodingkeyoftheimages.

Thesurfaceroughnessisshownbythecolordifferences.Blueindicatespits,andredindicates protrusions from the plane of the sample. Shades of green indicate roughness with a smaller peak-to-valley range.

DEB shades T shades

DEB shades T shades

Note the smoothness of the surfaces after polish. In all of the images above, there is little color variation, indicating little roughness (Ra14<20 nm).

Polished: 3M™ Filtek™ Supreme Ultra Universal Restorative.

Polished: 3M™ Filtek™ Supreme Plus Universal Restorative.


DEB shades T shades

DEB shades T shades

After 6,000 cycles of toothbrush abrasion, Wyko images were taken and the scale was changedtoaslightlysmallermagnification.Thesurfacesofthe3M™Filtek™SupremeUltraUniversal Restorative DEB (Ra~129 nm) and T shade (Ra~70 nm) samples exhibit very minor color variation across the samples.

The images below show the original 3M™ Filtek™ Supreme Plus Universal Restorative DEB and T shades (Ra~148 nm) after toothbrush abrasion. Note the few deeper blue areas where larger masses, probably clusters, were removed during toothbrush abrasion.

Toothbrush abraded: 3M™ Filtek™ Supreme Ultra Universal Restorative.

Toothbrush abraded: 3M™ Filtek™ Supreme Plus Universal Restorative.


Durafill® VS Renamel® Microfill

Ceram-X™ Nano Ceramic Restorative EsthetX® HD High Definition Micro Matrix Restorative

Gradia® Direct X Grandio®SO Universal Nano Hybrid Restorative

IntheCeram-X™NanoCeramicRestorativeimagebelow,thereisasignificantroughnessindicated due to the ragged appearing edges of the image and the yellow-orange hue of the surface (Ra~240 nm). The EsthetX®HDHighDefinitionMicroMatrixRestorativeimageexhibits a less uniform orange surface hue (Ra~187 nm). This indicates broader and larger concentrations of raised areas. Both have measurably greater surface roughness than 3M™ Filtek™ Supreme Ultra Universal Restorative materials.

Gradia® Direct X exhibits a very rough surface after toothbrush abrasions (Ra~287 nm). The Wyko image shows orange protrusions and deep blue valleys in the surface. The Grandio®SO Universal Nano Hybrid Restorative surface shows a smaller peak-to-valley ratio (Ra~226 nm) than Gradia® Direct X, but is still very rough (the color across the sample is not uniform).

Toothbrushabraded:microfills.

Toothbrush abraded: universals.

Belowareimagesgeneratedoftwomicrofillrestorativesaftertoothbrushabrasion. Noteinbothsamplesthehigherareasduetotheprepolymerizedfillerparticlesabrading atadifferentratethanthesurroundingresinmatrix(Ra~135nm).Notethedeeperblue areas where larger masses were removed, which is similar to 3M™ Filtek™ Supreme Plus Universal Restorative materials.


Herculite® XRV Ultra™ Premise™ Universal Composite

Tetric EvoCeram® Universal TPH® 3flow Liquid Micro Hybrid Restorative

Venus®

Inbothofthematerialsshownabove,thereareasignificantnumberofbumpsonthesurface(peaks),whichmaybefromfillerparticlesprotrudingasthesurroundingresinmatrixwasworn away (Herculite® XRV Ultra™ Ra~280 nm, Premise™ Universal Composite Ra~266 nm). In addition, Premise™ Universal Composite has several large valleys where a mass material was lost.

Theprepolymerizedfillerparticles(orangeprotrusions)inTetricEvoCeram® Universal become readily apparent in this surface analytic technique (Ra~542 nm). The color variation across the Tetric EvoCeram® Universal sample covers the entire range of this surface roughness analytic technique (+ 1.5um). TPH®3flowLiquidMicroHybridRestorative, ontheotherhand,exhibitsdeepvalleys(largeparticleloss)butmorediffusedpeakareas (orange hues) (Ra~348 nm).

The abrasion pattern of the Venus® sample is similar to that of Ceram-X™ Nano Ceramic Restorative. There is an obvious orange cast to the sample, indicating many peaks rising from the surface (Ra~147 nm). In addition, there are several deep blue striations that were created from the toothbrush abrasion test.




3-Body WearThe wear rate was determined by an in vitro 3-body wear test. In this test, composite (1st body) is loaded onto a wheel, which contacts another wheel, which acts as an “antagonistic cusp” (2nd body). The two wheels counter-rotate against one another, dragging abrasive slurry (3rd body) between them. Dimensional loss during 156,000 cyclesisdeterminedbyprofilometryatregularintervals(i.e.,afterevery39,000cycles). As the wear in this method typically follows a linear pattern, the data is plotted using linear regression. The wear rates, i.e., the slope of the lines, are determined. The comparison of rates reduces some of the variability in the test due to sample preparation and can be predictive of anticipated wear beyond the length of the actual test.




Durafill® VS


Gradia® Direct X


Renamel® Microfill

0 10

Venus®

5 20 3015

um/200,000 cycles25 35







The lower the wear rate, the better the wear resistance. The wear rate of 3M™ Filtek™ Supreme Ultra Universal Restorative DEB shades and T shades is comparable to the 3-body wear rate of 3M™ Filtek™ Supreme Plus UniversalRestorative.The3-bodywearrateisstatisticallysignificantlylower(morewearresistant)thanthemicrofillsDurafill® VS and Renamel®Microfill.Inaddition,itisstatisticallylowerthanCeram-X™NanoCeramicRestorative, Estelite® Sigma Quick, EsthetX®HDHighDefinitionMicroMatrixRestorative,Gradia® Direct X, Grandio®SO Universal Nano Hybrid Restorative, Herculite® XRV Ultra™, Premise™ Universal Composite, Tetric EvoCeram® Universal, TPH® 3flowLiquidMicroHybridRestorativeandVenus® universal restoratives.

Wear Rate

Wear rate. Source: 3M internal data


Fracture ToughnessThevaluesreportedforfracturetoughness(K1c)arerelatedtotheenergyrequired to propagate a crack. In this test, a short rod of material is cured. A notchiscutintothecylinder.Thecylinderisplacedonafixturethatsupportseither end and the stylus is positioned above the notch. This is similar to 3-point bend(similartothefixturethatprovidesflexuralstrengthandmodulusdata).




Durafill® VS

Gradia® Direct X

Venus®

Renamel® Microfill

0 0.5 1.51 2 2.5

K1c

Fracture Toughness

Fixture

Sample Notch

Anvil

Instron Fixture










Durafill® VS

Gradia® Direct X

Venus®

Renamel® Microfill

0 0.5 1.51 2 2.5

K1c

Fracture Toughness

Fixture

Sample Notch

Anvil

Instron Fixture







Fracture Toughness

The fracture toughness of 3M™ Filtek™ Supreme Ultra Universal Restorative (DEB shades) is comparable to 3M™Filtek™SupremePlusUniversalRestorative.FiltekSupremeUltrarestorativehasstatisticallysignificantlyhigherfracturetoughnessthanthemicrofillsDurafill® VS and Renamel®Microfill.ThefracturetoughnessofFiltekSupremeUltrarestorativeisalsostatisticallysignificantlyhigherthanGradia® Direct X and Tetric EvoCeram® Universal.

Fracture toughness. Source: 3M internal data


Compressive and Diametral Tensile StrengthCompressive strength is particularly important because of chewing forces. Rods are made of the material and simultaneous forces are applied to the opposite ends of the sample length. The sample failure is a result of shear and tensile forces.

The compressive strength of 3M™ Filtek™ Supreme Ultra Universal Restorative (DEB shades) is comparable to the T shades and 3M™ Filtek™ Supreme Plus Universal Restorative. Filtek SupremeUltrarestorativehasstatisticallysignificantlyhighercompressivestrengththanGradia® Direct X.

0 50 100 150 200 250 300 350 400 450

Compressive Strength




Durafill® VS


Gradia® Direct X


Renamel® Microfill

Venus®

MPa







0 50 100 150 200 250 300 350 400 450





Durafill® VS


Gradia® Direct X


Renamel® Microfill

Venus®

MPa








Compressive strength. Source: 3M internal data


Diametral tensile strength is measured using a similar apparatus. Compressive forces are applied to the sides of the sample, not the ends, until fracture occurs.

The diametral tensile strength of 3M™ Filtek™ Supreme Ultra Universal Restorative is comparable to 3M™ Filtek™ Supreme Plus Universal Restorative. The diametral tensilestrengthisstatisticallysignificantlyhigherthanthemicrofillsDurafill® VS and Renamel®Microfill. In addition, it is statistically higher than Ceram-X™ Nano Ceramic Restorative, Estelite® Sigma Quick, EsthetX® HDHighDefinitionMicroMatrixRestorative,Gradia® Direct X, Premise™ Universal Composite, Tetric EvoCeram® Universal, TPH® 3flowLiquidMicroHybridRestorativeandVenus® universal restoratives.

0 10 10020 30 40 50 60 70 80 90

Diametral Tensile Strength




Durafill® VS

Gradia® Direct X


Renamel® Microfill

Venus®

MPa








0 10 10020 30 40 50 60 70 80 90





Durafill® VS

Gradia® Direct X


Renamel® Microfill

Venus®

MPa









Diametral tensile strength. Source: 3M internal data

Flexural Strength and ModulusFlexuralstrengthisdeterminedinthesametestasflexuralmodulus.Flexuralstrength is the value obtained when the sample breaks. This test combines the forces found in compression and tension.

TheflexuralstrengthoftheDEBshadesof3M™Filtek™SupremeUltraUniversalRestorativeiscomparabletotheTshadesand3M™Filtek™SupremePlusUniversalRestorative.TheflexuralstrengthofFiltekSupremeUltrarestorativeissignificantlyhigherthanthemicrofillsDurafill® VS and Renamel®Microfill.Itisalsohigherthan the universal restoratives Ceram-X™ Nano Ceramic Restorative, Estelite® Sigma Quick, EsthetX® HD HighDefinitionMicroMatrixRestorative,Gradia® Direct X, Grandio®SO Universal Nano Hybrid Restorative, Herculite® XRV Ultra™, Premise™ Universal Composite, Tetric EvoCeram® Universal and Venus®.

0 20 20040 60 80 100 120 140 160 180

Flexural Strength




Durafill® VS


Gradia® Direct X


Renamel® Microfill

Venus®

MPa







0 20 20040 60 80 100 120 140 160 180

Flexural Strength




Durafill® VS


Gradia® Direct X


Renamel® Microfill

Venus®

MPa







Flexural strength. Source: 3M internal data


Flexural Strength

Flexuralmodulusisamethodofdefiningamaterial’sstiffness.Alowmodulusindicates aflexiblematerial.Theflexuralmodulusismeasuredbyapplyingaloadtoamaterial specimen that is supported at each end.

TheflexuralmodulusoftheDEBshadesof3M™Filtek™SupremeUltraUniversalRestorativeisstatisticallydifferentthantheTshades,Ceram-X™NanoCeramicRestorative,Durafill® VS, Estelite® Sigma Quick, EsthetX®HDHighDefinitionMicroMatrixRestorative,Gradia® Direct X, Grandio®SO Universal Nano Hybrid Restorative, Herculite® XRV Ultra™, Premise™ Universal Composite, Renamel®Microfill,TetricEvoCeram® Universal, TPH® 3flowLiquidMicroHybridRestorativeandVenus® restoratives. It is the same as 3M™ Filtek™ Supreme Plus Universal Restorative.

0 5000 10000 15000 20000 25000

Flexural Modulus




Durafill® VS


Gradia® Direct X


Renamel® Microfill

Venus®

MPa







0 5000 10000 15000 20000 25000

Flexural Modulus




Durafill® VS


Gradia® Direct X


Renamel® Microfill

Venus®

MPa







Flexural modulus. Source: 3M internal data


Flexural Modulus


3

Durafill® VS


Gradia® Direct X


Transducer

Cover Slide

Light

Deflection

Glass Slide




Venus®

Renamel® Microfill

0 0.5 1.51 2 2.5%

Shrinkage







3

Durafill® VS


Gradia® Direct X


Transducer

Cover Slide

Light

Deflection

Glass Slide




Venus®

Renamel® Microfill

0 0.5 1.51 2 2.5%

Shrinkage







Shrinkage. Source: 3M internal data

Volumetric ShrinkageAmethodfordeterminingpolymerizationshrinkagewasdescribedby Watts and Cash.15 In this method, a disc-shaped test specimen and uncured paste is sandwiched between two glass plates and light cured through the rigidlowerplate.Theflexibleupperplateisdeflectedduringthe polymerizationofthetestspecimen.Thelesstheflexibleplatebends,thelowertheshrinkage.Deflectionis measured and recorded as a function of time. Although this process actually measures linear shrinkage, volumetric shrinkage was closely approximated due to the fact that the dimensional changes were limited to the thickness dimension. The lower the value, the less the shrinkage.

Inthistest,sampleswereexposedfor60secondstoa3M™Visilux™2VisibleLightCuringUnit.Thefinalshrinkage was recorded 4 minutes after the end of light exposure.

Shrinkage

The volumetric shrinkage of 3M™ Filtek™ Supreme Ultra Universal Restorative DEB shades and T shades is statisticallydifferent.TheDEBshadesofFiltekSupremeUltrarestorativearestatisticallylowerthanEsthetX® HDHighDefinitionMicroMatrixRestorative,Herculite® XRV Ultra™, TPH® 3flowLiquidMicroHybridRestorative and Venus®.


Field EvaluationAfieldevaluationwasconductedwith256dentistsinthreecountries(U.S.,GermanyandItaly)toconfirm the in vitro handling and assess the esthetic clinical performance of 3M™ Filtek™ Supreme Ultra Universal Restorative. Recruited dentists were sent either capsules or syringes, depending on their delivery preference. In addition, they were screened on their typical composite shade technique. Dentists who were primarily single-shade users in a restoration were sent a selection of the Body shades. Dentists who typically layer multiple shades in a single restoration received a selection of all opacities.

Eighty-three dentists currently use 3M™ Filtek™ Supreme Plus Universal Restorative as their most frequently used composite. An additional 74 use it in their practice. One hundred and two were assessed to be primarily single-shade users, and 154 were multi-shade users (in a single restoration).

There were 25,858 placements: 12,606 in anterior restorations and 13,252 in the posterior.

Class V,2,540

Class III,3,599

Class IV,2,153

Direct Veneers,

390

Diastema,223

Class V,499 Class III,

1,514

Class IV,1,293

Direct Veneers,

247

Diastema,148

Multiplesurfacemolar,3,308

Premolar,2,818

Occlusalsurfacemolar,2,968

Class V,1,728

Indirect,204

Multiplesurfacemolar,

866

Premolar,749

Occlusalsurfacemolar,

444

Class V,160

Indirect, 7

Anterior Single Shade: 8,905 Anterior Multiple Shade: 3,701

Posterior Single Shade: 11,026 Posterior Multiple Shade: 2,226


Handling AcceptabilityThe handling ratings of 3M™ Filtek™ Supreme Ultra Universal Restorative were compared to the handling of their most frequently used composite. The data for current 3M™ Filtek™ Supreme Plus Universal Restorative users (labeled 3M™ Filtek™ Supreme Plus Universal Restorative) was separated from dentists using any other composite more frequently (labeled Competitive Product).

Dentists were asked to rate handling attributes on a 7-point scale. For Viscosity, Stickiness to Instrument, Flow and Ability to Hold Its Shape, a rating of 4 was ideal. For Ease of Shaping and Veneering, Ability to Use a Brush andCavity/MarginalAdaptation,aratingof7wasbest.

4.94.94.9

2

1

3

4

5

6

7

Viscosity Stickiness to Instrument Flow Ability to Hold Its Shape

4 is Ideal

0Too thick Not sticky enough Not enough Difficult to smooth

Does not hold shapeToo thin Too sticky Too much

2

1

3

4

5

3M™ Filtek™ Supreme UltraUniversal Restorative

3M™ Filtek™ Supreme PlusUniversal Restorative

6

7

Ease of Shaping Ease of Veneering Ability to Use a Brush Cavity/Marginal Adaptation

7 is Best

Competitive Product

0

Adapts easilyEasy Easy Brushable

Difficult Difficult Cannot Does not adapt



Competitive Product

4 is Ideal

Source: 3M internal data


4.94.94.9

2

1

3

4

5

6

7

Viscosity Stickiness to Instrument Flow Ability to Hold Its Shape

4 is Ideal

0Too thick Not sticky enough Not enough Difficult to smooth

Does not hold shapeToo thin Too sticky Too much

2

1

3

4

5



6

7

Ease of Shaping Ease of Veneering Ability to Use a Brush Cavity/Marginal Adaptation

7 is Best

Competitive Product

0

Adapts easilyEasy Easy Brushable

Difficult Difficult Cannot Does not adapt



Competitive Product

3M™ Filtek™ Supreme Plus Universal Restorative users rated the Viscosity, Stickiness to Instrument, Flow and Ability to Hold Its Shape of 3M™ Filtek™ Supreme Ultra Universal Restorative as ideal. In addition, the Viscosity, Stickiness to Instrument, Flow, Ability to Hold Its Shape, and the Ability to Use a Brush was rated statistically higher for Filtek Supreme Ultra restorative than their current product.

Competitive product users rated the Stickiness to Instrument of Filtek Supreme Ultra restorative as ideal. In addition, the Stickiness to Instrument, Flow and the Ability to Use a Brush were rated statistically higher for Filtek Supreme Ultra restorative than their current product.

7 is Best

Source: 3M internal data


Dentistswerealsospecificallyaskedtocompare3M™Filtek™SupremeUltraUniversalRestorativetotheircurrent product on a scale of 1 to 7. A rating of 1–3 indicated Filtek Supreme Ultra restorative was Much Worse to Worse than their current product. Ratings of 5–7 indicated Filtek Supreme Ultra restorative was Better to Much Better than their current product. A rating of 4 indicated Filtek Supreme Ultra restorative was performing similarly to their current product. (For the purpose of this report, the rating of 4 is not shown. It can be calculatedbysubtractingtheWorseandBetter%Respondentsfrom100.)

-70 -50 -30 -10 10 30 50 70

59%

49%

58%

60%

59%

36%

43%

31%

54%

54%

51%

Ease of polish

Ease of achieving your desired esthetic resultsEsthetic result with single-shade restorations

Esthetic result with multi-shade restorations

Shade blend withsurrounding dentition

Ease of selecting shade

Match to VITA classical Shade Guide

Ease of understanding shade system

Ease of use

Handling

Clinical performance

% Respondents

1 2 3 = 3M™ Filtek™ Supreme Ultra Universal Restorative is Much Worse to Worse

4 = 3M™ Filtek™ Supreme Ultra Universal Restorative is the Same (not shown)

5 6 7 = 3M™ Filtek™ Supreme Ultra Universal Restorative is Better to Much Better

1%

5%

4%

4%

2%

4%

4%

5%

14%

10%

4%

Worse Better

Supreme Users

• Handling

• Ease of use

• Clinical performance

Thischartshowstheresponseofthecurrent3M™Filtek™SupremePlusUniversalRestorativeusers.Over50%of the current Filtek Supreme Plus restorative users felt Filtek Supreme Ultra restorative exhibited improved:

• Ease of polish

• Results with single- and multi-shade restorations

• Shade blend with surrounding dentition

Inallaspectsexcepthandling,morethan90%ofusersagreedtheperformanceofFiltekSupremeUltrarestorativewasthesameorbetterthanFiltekSupremePlusrestorative.Morethan85%ratedthehandling of Filtek Supreme Ultra restorative as the same or better than Filtek Supreme Plus restorative.

3M™ Filtek™ Supreme Plus Universal Restorative Users


54%

54%

51%

57%

56%

40%

43%

38%

59%

53%

53%

10%

14%

14%

13%

11%

16%

7%

20%

14%

16%

10%

Worse Better

Competitive Users

-70 -50 -30 -10 10 30 50 70

Ease of polish

Ease of achieving your desired esthetic results

Esthetic result with single-shade restorations

Esthetic result with multi-shade restorations

Shade blend withsurrounding dentition

Ease of selecting shade

Match to VITA classical Shade Guide

Ease of understanding shade system

Ease of use

Handling

Clinical performance

% Respondents

1 2 3 = 3M™ Filtek™ Supreme Ultra Universal Restorative is Much Worse to Worse

4 = 3M™ Filtek™ Supreme Ultra Universal Restorative is the Same (not shown)

5 6 7 = 3M™ Filtek™ Supreme Ultra Universal Restorative is Better to Much Better

Thischartshowstheresponseofthecurrentcompetitiveproductusers.Over50%ofthecurrentcompetitiveproduct users felt 3M™ Filtek™ Supreme Ultra Universal Restorative exhibited improved:

• Ease of polish

• Ease of achieving your desired esthetic result

• Results with single- and multi-shade restorations

• Shade blend with surrounding dentition

In all aspects except ease of selecting shade, ease of understanding the shade system and ease of use, more than85%ofusersagreedtheperformanceofFiltekSupremeUltrarestorativewasthesameorbetterthantheir current product. Many of these dentists were not familiar with 3M™ Filtek™ Supreme Plus Universal Restorative. Dentists in this study did not receive any shade reference card or shade wheel to assist in shade identification.Evenwiththishandicap,thesethreeattributeswereratedthesameorbetterthancompetitiveproductsby80%ofthedentists.

• Handling

• Ease of use

• Clinical performance

Competitive Product Users


• This system is too complicated for me. Most of the time I use only one shade in my restorations.

The3M™Filtek™SupremeUltraUniversalRestorativesystemisdesignedtobeflexible to meet the needs of every dentist. While there are four opacities available, dentists using only one shade in a restoration can use the Body shades. Use of all opacities in this system is not required, but optional.

• The Translucent shades are very transparent. Tooth structure is not. Where can I use this type of material?

The Translucent shades can be used either internally or externally in a restoration. These materialscanbeusedtoaccentuatetherecreateddentinmamelonsandmaximizetranslucency of an incisal edge. In addition, they can be used as a very thin layer over the surface of the restoration to take advantage of their excellent polish retention.

• What is the difference between 3M™ Filtek™ Supreme Plus Universal Restorative and Filtek Supreme Ultra restorative?

Therehavebeenimprovementsmadeinthefillerprocessingandpigmentstoprovidebetterpolishretention,improvedfluorescenceandFiltekSupremePlus-likehandlingforallopacities, including translucent.

• Can I use my old shade wheel (from Filtek Supreme Plus restorative) or recipes to create multi-shaded restorations?

Yes.Thecolortargetsfortheshadesremainthesame.However,duetothemodifiedshadeoffering,anewwheel(andrecipes)wascreatedtotakeadvantageofthisenhancement.

Questions and Answers


1. Mitra, S.B., Wu, D., & Holmes, B.N. (2003). Journal of the American Dental Association, 134, 1382–1390.

2. KatholiekeUniversiteitLeuvenclinicalstudy.

3. Dentin, Enamel and Body shades will be referred to as DEB shades throughout this document.

4. Translucent shades will be referred to as T shades throughout this document.

5. Takahashi,M.K.,Viera,S.,Rached,R.N.,Almeida,J.B.,Aguiar,M.,&Souza,E.M.(2008).Operative Dentistry, 33(2), 189–195.

6. Kobussen,G.A.,Craig,B.D.,Halvorson,R.H.,Doruff,M.C.,&Bigham,W.S.(2009). Optical Properties of Highly Aesthetic Composite Restoratives, Journal of Dental Research, 88(Spec Iss A), 1508.

7. Lee,Y.K.(2005).MeasurementofOpalescenceofResinComposites.Dental Materials, 21, 1068–1074.

8. Kobussen,G.A.

9. Dr. Jorge Perdigao, University of Minnesota, Division of Operative Dentistry, Department of Restorative Science.

10. Uncured paste was dissolved in acetone and then centrifuged. The supernatant liquid was removed and the residue dissolved in acetone, then centrifuged.

11. AFM—Atomic Force Microscopy in a 3D surface plot. Scanned area is about 100um2. The Tapping Mode AFM uses a single crystal silica probe with a force constant of~40N/mtodeterminethesurfaceprofile.Thedarkerthecolor,thedeeperthegouge;the lighter the color, the higher the peak (the pink color indicates the maximum instrument capability).

12. Ibid

13. Ibid

14. Ra is the arithmetic average of the absolute values of the surface height deviations from themeansurfaceplanecalculatedfromthe500x500µ2 Wyko maps.

15. Watts, D.C., & Cash, A.J. (1991). Measurement Science and Technology, 2, 788–794.

Endnotes


Technical Data Summary


Universal Restorative(DEB shades)


Universal Restorative(T shades)

Ceram-X™Nano

CeramicRestorative

Durafill®VS

Compressive Strength MPaStDev

MPaStDev

MPaStDev

MPaStDev

K1cStDev

%StDev

370.5615.13

86.123.91

165.1413.59

11,348.00271.00

1.840.19

1.970.03

394.0125.05

90.641.40

157.988.16

9,180.00431.00

1.510.03

2.480.06

361.3723.78

85.535.47

165.905.40

11,436.00442.00

1.920.21

2.060.06

346.8022.96

63.316.49

113.6811.52

8,830.00379.00

1.690.05

1.970.05

349.8610.40

55.892.87

64.503.62

2,613.0066.00

1.010.09

2.000.08

Level

Flexural Strength


Flexural Modulus

Fracture Toughness

Shrinkage

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

um lostStDev

94.831.03

86.825.77

83.325.96

76.556.43

73.195.99

70.335.52

69.665.36

68.624.77

5.610.63

93.831.39

88.046.01

85.725.60

82.835.12

82.015.96

81.234.15

79.806.05

79.724.42

6.540.50

92.812.35

83.096.08

78.737.69

69.748.57

62.898.69

56.637.28

53.488.19

54.737.75

5.070.80

72.90—

36.037.27

25.506.39

23.182.74

10.451.37

9.801.23

9.551.00

7.980.71

32.040.68

86.330.15

74.824.85

68.085.67

59.036.15

58.703.38

55.676.57

54.023.57

53.216.32

15.220.55

Polish Retention

Initial

1,000 cycles

500 cycles

2,000 cycles

3,000 cycles

4,000 cycles

5,000 cycles

6,000 cycles

3-Body Wear Rate



Estelite®

Sigma Quick

EsthetX® HDHigh Definition

Micro MatrixRestorative

Grandio®SOUniversal

Nano HybridRestorative

Herculite®

XRV Ultra™

Premise™Universal

CompositeGradia®

Direct X


MPaStDev

MPaStDev

MPaStDev

K1cStDev

%StDev

364.1914.03

77.562.98

111.083.94

7,552.00202.00

——

1.800.05

376.8335.41

73.642.38

132.908.65

10,128.00146.00

1.700.12

2.580.05

323.407.92

52.825.89

106.076.77

6,299.00185.00

1.050.06

1.920.04

341.8416.04

81.285.63

144.0317.54

19,437.00299.00

1.680.07

1.690.04

349.1023.51

80.655.76

106.4814.34

7,679.00541.00

——

2.700.07

370.8118.83

65.898.18

108.649.64

7,839.00183.00

1.810.03

1.660.06

Level

Flexural Strength


Flexural Modulus

Fracture Toughness

Shrinkage

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

um lostStDev

93.930.68

67.627.45

64.143.75

63.553.88

64.299.89

62.353.66

63.309.53

65.013.33

7.500.46

92.452.33

54.753.86

27.651.03

25.052.64

29.282.59

26.786.12

28.680.65

27.651.01

7.380.31

76.170.32

37.9810.27

21.5812.86

13.535.00

13.000.81

10.470.89

11.771.16

10.551.22

15.171.43

67.271.71

43.474.82

35.316.34

20.793.29

17.262.81

13.131.33

12.160.96

11.480.98

8.490.64

89.672.17

69.639.21

60.837.29

54.896.85

52.5711.34

53.715.48

52.8411.58

54.884.57

15.782.13

91.600.96

70.365.97

63.115.81

49.358.48

44.124.93

39.296.97

39.263.12

37.185.00

16.270.55

Polish Retention

Initial

1,000 cycles

500 cycles

2,000 cycles

3,000 cycles

4,000 cycles

5,000 cycles

6,000 cycles

3-Body Wear Rate





Universal Restorative(T shades)

Ceram-X™Nano

CeramicRestorative

Durafill®VS


MPaStDev

MPaStDev

MPaStDev

K1cStDev

%StDev

370.5615.13

86.123.91

165.1413.59

11,348.00271.00

1.840.19

1.970.03

394.0125.05

90.641.40

157.988.16

9,180.00431.00

1.510.03

2.480.06

361.3723.78

85.535.47

165.905.40

11,436.00442.00

1.920.21

2.060.06

346.8022.96

63.316.49

113.6811.52

8,830.00379.00

1.690.05

1.970.05

349.8610.40

55.892.87

64.503.62

2,613.0066.00

1.010.09

2.000.08

Level

Flexural Strength


Flexural Modulus

Fracture Toughness

Shrinkage

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

um lostStDev

94.831.03

86.825.77

83.325.96

76.556.43

73.195.99

70.335.52

69.665.36

68.624.77

5.610.63

93.831.39

88.046.01

85.725.60

82.835.12

82.015.96

81.234.15

79.806.05

79.724.42

6.540.50

92.812.35

83.096.08

78.737.69

69.748.57

62.898.69

56.637.28

53.488.19

54.737.75

5.070.80

72.90—

36.037.27

25.506.39

23.182.74

10.451.37

9.801.23

9.551.00

7.980.71

32.040.68

86.330.15

74.824.85

68.085.67

59.036.15

58.703.38

55.676.57

54.023.57

53.216.32

15.220.55

Polish Retention

Initial

1,000 cycles

500 cycles

2,000 cycles

3,000 cycles

4,000 cycles

5,000 cycles

6,000 cycles

3-Body Wear Rate



Estelite®

Sigma Quick

EsthetX® HDHigh Definition

Micro MatrixRestorative

Grandio®SOUniversal

Nano HybridRestorative

Herculite®

XRV Ultra™

Premise™Universal

CompositeGradia®

Direct X


MPaStDev

MPaStDev

MPaStDev

K1cStDev

%StDev

364.1914.03

77.562.98

111.083.94

7,552.00202.00

——

1.800.05

376.8335.41

73.642.38

132.908.65

10,128.00146.00

1.700.12

2.580.05

323.407.92

52.825.89

106.076.77

6,299.00185.00

1.050.06

1.920.04

341.8416.04

81.285.63

144.0317.54

19,437.00299.00

1.680.07

1.690.04

349.1023.51

80.655.76

106.4814.34

7,679.00541.00

——

2.700.07

370.8118.83

65.898.18

108.649.64

7,839.00183.00

1.810.03

1.660.06

Level

Flexural Strength


Flexural Modulus

Fracture Toughness

Shrinkage

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

MeanStDev

um lostStDev

93.930.68

67.627.45

64.143.75

63.553.88

64.299.89

62.353.66

63.309.53

65.013.33

7.500.46

92.452.33

54.753.86

27.651.03

25.052.64

29.282.59

26.786.12

28.680.65

27.651.01

7.380.31

76.170.32

37.9810.27

21.5812.86

13.535.00

13.000.81

10.470.89

11.771.16

10.551.22

15.171.43

67.271.71

43.474.82

35.316.34

20.793.29

17.262.81

13.131.33

12.160.96

11.480.98

8.490.64

89.672.17

69.639.21

60.837.29

54.896.85

52.5711.34

53.715.48

52.8411.58

54.884.57

15.782.13

91.600.96

70.365.97

63.115.81

49.358.48

44.124.93

39.296.97

39.263.12

37.185.00

16.270.55

Polish Retention

Initial

1,000 cycles

500 cycles

2,000 cycles

3,000 cycles

4,000 cycles

5,000 cycles

6,000 cycles

3-Body Wear Rate

3M, ESPE, Filtek and Visilux are trademarks of 3M or 3M Deutschland GmbH. Used under license in Canada. © 3M 2017. All rights reserved. All other trademarks are not trademarks of 3M.70-2013-0842-9

www.3M.com/FiltekSupremeUltra

3M Oral Care2510 Conway AvenueSt. Paul, MN 55144-1000 USA

Phone 1-800-634-2249Web 3M.com/dental

3M Canada Post Office Box 5757London, Ontario N6A 4T1 Canada

Phone 1-888-363-3685

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